Upper Gastrointestinal Bleeding

Patel, Vihas; Nicastro, Jeffrey

doi:10.1055/s-0039-1695037

Cited by 8 publications

(8 citation statements)

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“…La HDA constituye uno de los principales motivos de hospitalización por enfermedades del tracto gastrointestinal, y se puede acompañar de una significativa morbimortalidad en grupos de riesgo, como son los pacientes mayores de 65 años. De modo general, la tasa cruda de la HDA a nivel mundial va entre 37 a 172 casos por cada 100.000 habitantes por año 5 . Los factores de riesgo no variceales más comunes, como la úlcera péptica (UP) y el uso de fármacos (AINEs y aspirina) se han asociado a mayores tasas de incidencia y mortalidad 6 .…”

Section: Epidemiologíaunclassified

“…Cabe destacar que la UP provocada por la colonización por H. pylori concentra cerca del 60% a 70% de casos nuevos cada año 7 . A pesar de los variados factores causantes de la HDA no variceal, se observa una disminución de su incidencia a nivel mundial, gracias al manejo oportuno de la UP y los nuevos tratamientos farmacológicos contra la infección por H. pylori 5 . La mortalidad a nivel mundial ha sido reportada entre 5% a 14% en algunos estudios.…”

Section: Epidemiologíaunclassified

“…Tabla 6. Exámenes de laboratorios básicos para el estudio de la HDA Exámenes de laboratorio a solicitar para apoyar a la evaluación del paciente 5 Hemograma con VHS: En este examen podría verse alterado el hematocrito (Hto), la hemoglobina (Hb) y el recuento de glóbulos rojos. Sin embargo, estos parámetros no son muy útiles en la fase aguda ya que no tienden a disminuir, sólo reduciéndose a medida que el organismo recupera su volemia.…”

Section: Manejo Preendoscópicounclassified

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Conducta actual frente a la Hemorragia Digestiva Alta: Desde el diagnóstico al tratamiento.

et al. 2021

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La hemorragia digestiva alta (HDA) es una emergencia médico-quirúrgica común que debe ser tratada precozmente por su alta morbimortalidad. Corresponde a sangrado del esófago, estómago o del duodeno proximal, y se divide en etiología no variceal y variceal. Dentro de las no variceales destaca la úlcera péptica como la más frecuente, siendo esta producida por un desbalance entre factores protectores y agresivos. Por otro lado, en las hemorragias variceales destacan las várices gastroduodenales, las cuales son consecuencia del aumento de la presión portal. La incidencia de la HDA a nivel mundial varía entre 37 a 172 casos por cada 100.000 habitantes por año y la mortalidad entre un 5 y un 14% según diferentes estudios. Lamentablemente, no existen cifras nacionales fidedignas de incidencia y prevalencia. El médico debe conocer bien la presentación clínica y la fisiopatología para ser asertivo en la sospecha, diagnóstico y manejo de esta patología. En cuanto al tratamiento, el enfrentamiento se divide en el manejo de urgencias y luego endoscópico, puesto que la resucitación temprana intensiva puede reducir la morbimortalidad en pacientes con HDA. A continuación se hará una revisión actualizada enfocada en los aspectos más relevantes del manejo de esta patología. Se obtuvieron los datos de Pubmed y Scielo, específicamente la búsqueda de artículos originales y de revisiones sistemáticas con las palabras “hemorragia digestiva alta”, “úlcera péptica”, “várices esofágicas” y otras relacionadas. Los criterios usados fueron artículos preferentemente menores a 5 años de publicación en revistas científicas de alto índice de impacto.

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Section: Epidemiologíaunclassified

Section: Manejo Preendoscópicounclassified

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Conducta actual frente a la Hemorragia Digestiva Alta: Desde el diagnóstico al tratamiento.

et al. 2021

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“…The initial approach to these patients should focus primarily on adequate fluid replacement and blood transfusion if needed [3]. Secondly, upper gastrointestinal (GI) endoscopy is the preferred diagnostic tool to find the bleeding source, and it also allows therapeutic approaches [4]. The most common identified cause of NVUGIB is peptic ulcer disease, followed by erosive esophagitis, Dieulafoy lesion, Mallory-Weiss syndrome, gastric antral vascular ectasia, and neoplasms [3, 5].…”

Section: Introductionmentioning

confidence: 99%

The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding

Maia

Falcão

Silva

et al. 2021

GE Port J Gastroenterol

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Introduction: Risk stratification in patients with nonvariceal upper gastrointestinal bleeding (NVUGIB) is crucial for proper management. Rockall score (RS; pre-endoscopic and complete) and Glasgow-Blatchford score (GBS) are some of the most used scoring systems. This study aims to analyze these scores’ ability to predict various clinical outcomes and possible cutoff points to identify low- and high-risk patients. Secondarily, this study intents to evaluate the appropriateness of patients’ transfers to our facility, which provides a specialized emergency endoscopy service. Methods: This study was retrospectively conducted at Centro Hospitalar Universitário do Porto and included patients admitted to the Emergency Department with acute manifestations of NVUGIB between January 2016 and December 2018. Receiver operating characteristic (ROC) curves and corresponding areas under the curve (AUC) were calculated. Transferred patients from other institutions and nontransferred (directly admitted to this institution) patients were also compared. Results: Of a total of 420 patients, 23 (5.9%) died, 34 (8.4%) rebled, 217 (51.7%) received blood transfusion, 153 (36.3%) received endoscopic therapy, 22 (5.7%) had surgery, and 171 (42.3%) required hospitalization in the Intermediate or Intensive Care Unit. Regarding mortality prediction, both complete RS (AUC 0.756, p < 0.001) and pre-endoscopic RS (AUC 0.711, p = 0.001) showed good performance. In the prediction of rebleeding, only complete RS (AUC 0.735, p < 0.001) had discriminative ability. GBS had good performance in the prediction of transfusion (AUC 0.785, p < 0.001). No score showed discriminative capability in the prediction of other outcomes. Transferred and nontransferred patients had similar pre-endoscopic RS (3.41 vs. 3.34, p = 0.692) and GBS (13.29 vs. 12.29, p = 0.056). Only patients with GBS ≥6 were transferred to our facility. There were no adverse outcomes recorded in any group when GBS was ≤3. Discussion/Conclusion: Complete RS and pre-endoscopic RS are effective at predicting mortality, but only complete RS showed good performance at predicting rebleeding. GBS is better at predicting transfusion requirement. Our study suggests that a transfer can possibly be reconsidered if GBS is ≤3, although current recommendations only propose outpatient care when GBS is 0 or 1. Patients’ transfers were appropriate, considering the high GBS scores and the outcomes of these patients.

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“…Гострі виразкові кровотечі (ГВК) залишаються однією із злободенних проблем сучасної медицини [1][2][3][4]. Попри вагомі успіхи в лікуванні цієї патології, летальність, зумовлена ГВК, становить 10-15 % і збільшується до 50 % у разі виникнення рецидивних кровотеч [1,4]. Водночас частота рецидивів сягає 40-50 % [1].…”

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Experimental justification of the method of endoscopic hemostasis

Dutka¹,

Grynchuk²,

Давыденко³

et al. 2020

CAOS

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To study the possibility and effectiveness of using succinylated gelatin (SG) for injecting endoscopic hemostasis. Material and methods. 70 albino non-linear rats. 0.5 ml of the solution has been injected into the anterior wall of the stomach with a syringe after laparotomy. A mixture of 0.9 % NaCl solution and epinephrine hydrothartrate (1.8 mg/1 ml) has been used in a ratio of 1:20 for the control group (35 animals). A mixture of a solution of SG (40 mg/1000 ml of injection water) and epinephrine hydrothartrate (1.8 mg/1 ml) in a ratio of 1:20 for the experimental group (35 animals). Right after the injection and in 1, 3, 6, 12 hours, after laparotomy, the stomach wall has been taken for histological examination, during which the thickness of the stomach wall (TSW) has been determined. Results. As soon as the injection has been given, the TSW in animals of both groups hasn`t differed significantly. The TSW has significantly increased in both of the groups, and the parameters of indicators in the experimental group have significantly raised in 1 h after the injection. In 3, 6, and 12 hours, the TSW in both groups has been decreasing. The parameters of indicators in the experimental group of animals have been significantly higher than in the control one all the time during the study. The indicators have barely differed from the initial ones in the control group 12 hours later, whereas in the experimental one they have been significantly higher. Histological studies have shown that the structure of stomach tissues in both groups hasn`t varied. The SG injection has not caused any negative effects on the tissues of the stomach wall. The thickness of the submucosa hasn`t been much modified right after the injection. The thickness (26.95±5.34 microns) has increased in the experimental group 12 hours later than in the control one (15.45±4.38 microns, p<0.01). Most of the vessels of the experimental group have remained compressed 12 hours later, whereas the diameter of the vessels of the control group has been growing. Conclusions. 1. The TSW hasn`t differed right after the injection (a mixture of 0.9 % NaCl and epinephrine solution and a mixture of SG and epinephrine solution) into the stomach wall. 2. 1 h later after the injection, the TSW has increased and its parameters after injection of a mixture with SG have been significantly higher. 3. In 3,6,12 h and later on, the TSW has been gradually reducing and its parameters after injection of a mixture with SG have been significantly higher each time. The thickness of the submucosa and the degree of compression of the vessels have also been considerably higher. 4. No negative changes in the structure of stomach tissues after injection of the mixture with SG have been detected. This allows it to be used for performing endoscopic hemostasis by injection therapy in clinical conditions.

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Upper Gastrointestinal Bleeding

Abstract: Although its incidence is decreasing, upper gastrointestinal bleeding represents a significant cause of morbidity and mortality. We present the most common sources of upper gastrointestinal bleeding and treatments.

Cited by 8 publications

References 14 publications

Conducta actual frente a la Hemorragia Digestiva Alta: Desde el diagnóstico al tratamiento.

Conducta actual frente a la Hemorragia Digestiva Alta: Desde el diagnóstico al tratamiento.

The Clinical Impact of Rockall and Glasgow-Blatchford Scores in Nonvariceal Upper Gastrointestinal Bleeding

Experimental justification of the method of endoscopic hemostasis

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